Zika Virus in Pregnancy.
Zika Virus has been in the news quite a bit. It seems very bad. How bad is it?
7 days ago there were very few cases known and published in the US.
3 days ago there were 33 cases. All were cases caught outside the US, and brought here.
Yesterday was the first case caught in the US, given from one person to another by sexual exposure. Sexual transmission seems to be a previously unknown method of transmission of Zika Virus.
As of yet, there are no known mosquito transmissions in the mainland US. Although Puerto Rico, Guam, etc may be at higher risk, because of their tropical climates.
It seems inevitable that there will be mosquito borne cases in the US.
In Brazil, there are 4000 cases of microcephaly in newborns. This is a huge increase, and is thought to be possibly from Zika infections. Zika seems to have an outsize affect on neural tissue. Zika gives adults a case of Guillen Barre Syndrome:
https://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome
Guillen Barre is a disorder of neural tissue.
And in fetuses, it somehow affects the neural tissue of unborn children. Somehow the neural tissue is destroyed. I have seen the CT scan pictures, and the brains are seemly destroyed, at least partially. It is a real disaster for these children, families, and societies. I don't think anyone knows for sure how the neural tissue is destroyed but it is certainly possible that the virus gets into the cells, grows there, and kills the cells. Once the brains are destroyed, the head stops growing, and the child has a small head. This is called microcephaly.
There are no antizika antiviral medicines.
There is no Zika vaccine.
There are no antizika antiviral medicines.
There is no Zika vaccine.
The official position of the Brazilian Government is that women should put off being pregnant until something more is known about Zika Virus. This will take some time. Delaying an entire countries childbearing has not been done in recent memory. Again, this is something new.
As of this moment, there are far more questions than answers about Zika.
Here are a few helpful links:
http://www.cdc.gov/zika/pregnancy/question-answers.html
http://wwwnc.cdc.gov/travel/page/zika-information
http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html
http://www.cdc.gov/zika/pregnancy/index.html
http://mothertobaby.org/fact-sheets/deet-nn-ethyl-m-toluamide-pregnancy/pdf/
There are a few facts:
Eliminating mosquito bites will likely eliminate risk. How can we eliminate mosquito bites?
-Keep doors, windows, and screens closed.
-Don't travel to tropical climates right now, without precautions.
-Don't have unsafe sex with anyone who has been to a Zika prevalent area.
-When summer comes use air conditioning. Mosquites prefer the warmth. Cold keeps the mosquitoes out or inactive.
-If outside, use long tight pants, sleeves, socks, etc.
-Use special clothes that are permeated with permethrin. Personally, I have never seen such clothes for sale, but this is what the CDC says to do. I suppose if you can get Permethrin, you can spray your own clothes with it.
-Use highly effective insect repellent. DEET seems to be the best, in my opinion. Use it on all exposed skin, and even on your clothes. And use it even if pregnant. Use it copiously.
-Don't go outside when mosquitoes are active and present.
-Remove all standing water from the land. This is where mosquitoes breed.
-Treat standing water with insecticide or some other effective treatment.
-Use insect foggers outside, on a personal or municipal basis.
And finally, as a society, we need to control the Aedes Aegypti mosquitoes.
https://en.wikipedia.org/wiki/Aedes_aegypti.
This is not the only nasty virus or disease transmitted by this mosquito.
There are some biological control mechanisms to control this mosquito. But we will have to get over our natural inclination to protect species. It is rare for humans to conduct deliberate annihilation of a species, but it has been done before. Smallpox has been destroyed. Some agricultural pests have been destroyed. Other infectious diseases are on their way out. If we can vaccinate everybody we can stop more infectious diseases. But vaccinating everyone requires some force, as there will always be selfish individuals who wish to take advantage of the herd immunity we provide them, while not simultaneously helping to provide that immunity. These individuals will need to be either convinced or coerced. Somehow. My personal politics preclude the use of force on people, but I would support some kind of strong coercion for this. Like keeping unvaccinated kids out of schools.
Worldwide, 140,000 people die of measles every year:
http://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/29624385/
These deaths are preventable with the vaccine. Everyone who declines the vaccine is part of the problem, not the solution. We all must accept the risk of the vaccine in order to benefit from the vaccine. And the risk of the vaccine is very very low. My children have been vaccinated as per the normal schedule. There was no doubt in my mind that it was a good idea. And now my kids cannot kill anyone by transmitting measles to someone. This, to me, is profoundly beneficial. And sensible.
So this Zika virus is going to infect a lot more people.
We can control it in the USA because we have measures to control mosquitoes that other nations don't have. Of note, living in a cold climate is not a protection. As anyone who has fished in Canada or Alaska knows, in the summer, there are tons of mosquitoes. And the mosquitoes come back every year. They survive the winter.
We have been down this road before. West Nile Virus was a similar kind of event. Ebola had a very high mortality, but was controlled with really heroic efforts by some people who deserve a Nobel Prize, like Doctors Without Borders. There are significant new epidemics every year or two.
And in fiction, I have read several doomsday novels about killer viruses. Mostly man made viruses.
Steven King wrote "The Stand". There is a very good movie as well.
More recently, Russel Blake wrote "Upon a Pale Horse".
Both are good books.
Here is a list of books about epidemics:
http://www.goodreads.com/list/show/19535.Best_Fiction_Books_About_Diseases_or_Viruses
Please use the links above. I hope to be able to give better answers in the future.
Thanks
Dr Marcus
Blog is at doctorjohnmarcus.blogspot.com
89 North Maple Ave
Ridgewood NJ USA 07450
http://wwwnc.cdc.gov/travel/page/zika-information
http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html
http://www.cdc.gov/zika/pregnancy/index.html
http://mothertobaby.org/fact-sheets/deet-nn-ethyl-m-toluamide-pregnancy/pdf/
There are a few facts:
Eliminating mosquito bites will likely eliminate risk. How can we eliminate mosquito bites?
-Keep doors, windows, and screens closed.
-Don't travel to tropical climates right now, without precautions.
-Don't have unsafe sex with anyone who has been to a Zika prevalent area.
-When summer comes use air conditioning. Mosquites prefer the warmth. Cold keeps the mosquitoes out or inactive.
-If outside, use long tight pants, sleeves, socks, etc.
-Use special clothes that are permeated with permethrin. Personally, I have never seen such clothes for sale, but this is what the CDC says to do. I suppose if you can get Permethrin, you can spray your own clothes with it.
-Use highly effective insect repellent. DEET seems to be the best, in my opinion. Use it on all exposed skin, and even on your clothes. And use it even if pregnant. Use it copiously.
-Don't go outside when mosquitoes are active and present.
-Remove all standing water from the land. This is where mosquitoes breed.
-Treat standing water with insecticide or some other effective treatment.
-Use insect foggers outside, on a personal or municipal basis.
And finally, as a society, we need to control the Aedes Aegypti mosquitoes.
https://en.wikipedia.org/wiki/Aedes_aegypti.
This is not the only nasty virus or disease transmitted by this mosquito.
There are some biological control mechanisms to control this mosquito. But we will have to get over our natural inclination to protect species. It is rare for humans to conduct deliberate annihilation of a species, but it has been done before. Smallpox has been destroyed. Some agricultural pests have been destroyed. Other infectious diseases are on their way out. If we can vaccinate everybody we can stop more infectious diseases. But vaccinating everyone requires some force, as there will always be selfish individuals who wish to take advantage of the herd immunity we provide them, while not simultaneously helping to provide that immunity. These individuals will need to be either convinced or coerced. Somehow. My personal politics preclude the use of force on people, but I would support some kind of strong coercion for this. Like keeping unvaccinated kids out of schools.
Worldwide, 140,000 people die of measles every year:
http://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/29624385/
These deaths are preventable with the vaccine. Everyone who declines the vaccine is part of the problem, not the solution. We all must accept the risk of the vaccine in order to benefit from the vaccine. And the risk of the vaccine is very very low. My children have been vaccinated as per the normal schedule. There was no doubt in my mind that it was a good idea. And now my kids cannot kill anyone by transmitting measles to someone. This, to me, is profoundly beneficial. And sensible.
So this Zika virus is going to infect a lot more people.
We can control it in the USA because we have measures to control mosquitoes that other nations don't have. Of note, living in a cold climate is not a protection. As anyone who has fished in Canada or Alaska knows, in the summer, there are tons of mosquitoes. And the mosquitoes come back every year. They survive the winter.
We have been down this road before. West Nile Virus was a similar kind of event. Ebola had a very high mortality, but was controlled with really heroic efforts by some people who deserve a Nobel Prize, like Doctors Without Borders. There are significant new epidemics every year or two.
And in fiction, I have read several doomsday novels about killer viruses. Mostly man made viruses.
Steven King wrote "The Stand". There is a very good movie as well.
More recently, Russel Blake wrote "Upon a Pale Horse".
Both are good books.
Here is a list of books about epidemics:
http://www.goodreads.com/list/show/19535.Best_Fiction_Books_About_Diseases_or_Viruses
Please use the links above. I hope to be able to give better answers in the future.
Thanks
Dr Marcus
Blog is at doctorjohnmarcus.blogspot.com
89 North Maple Ave
Ridgewood NJ USA 07450
No comments:
Post a Comment